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Author Topic: First numbers  (Read 1888 times)

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Offline mdh26

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  • Posts: 27
First numbers
« on: February 14, 2011, 10:49:20 AM »
So I just got my first sets of numbers.

Here's my history thus far:

Infected weekend of Dec 11th
acute hiv symptoms Dec 24th-28th

Dec 28th -
HIV Antibody - Neg
Viral load - 950k

Jan 4 - first ID doctors Appt.
Got blood taken for resistance testing and CD4
CD4 - 626 42%
Started Atripla

Feb 5 - blood taken
CD4 - 708 42%
VL - 200
HIV Antibody - Neg

Feb 14 - Second doctors appt.
Resistant to AZT, Sustiva
And I'm switching to Truvada and Isentress starting tonight.


So a couple questions. First, what's up with the negative result at 8 weeks? How rare is this?

Second, I was on Atripla for 6 weeks with apparently very good results, despite having resistance to Sustiva - What are the chances of me having developed resistance to truvada in this period, and should I get another set of resistance tests when i get blood taken again?


Offline RapidRod

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Re: First numbers
« Reply #1 on: February 14, 2011, 11:51:42 AM »
What is the antibody negative?

Offline mdh26

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Re: First numbers
« Reply #2 on: February 14, 2011, 12:14:29 PM »
What is the antibody negative?

Do you mean what test was used? I believe ELISA, both times (at 2.5 weeks and 8 weeks post exposure). Negative both times. My viral load tests (including the 950,000 one) were PCR RNA.

Delayed positive result because of starting HAART 3 weeks post exposure I'm assuming is the most likely explanation. But does that make sense considering I had acute symptoms prior to starting treatment?
« Last Edit: February 14, 2011, 12:17:04 PM by mdh26 »

Offline newt

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Re: First numbers
« Reply #3 on: February 14, 2011, 12:47:10 PM »
I find this hard to make sense of and am confused, not least by your doc's flaky off-label off-guideline approach to HIV treatment during primary infection.

- matt
"The object is to be a well patient, not a good patient"

Offline surf18

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  • Posts: 525
Re: First numbers
« Reply #4 on: February 14, 2011, 12:49:09 PM »
I thought no antibody no HIV?

Offline Wrist

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Re: First numbers
« Reply #5 on: February 14, 2011, 01:05:52 PM »
I was infected at the end of July in 09. I was tested the last week of Oct. 09 and the western blot came back neg but I had a VL of 5 million. Everyone develops antibodies at different times.

Offline mdh26

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  • Posts: 27
Re: First numbers
« Reply #6 on: February 14, 2011, 01:11:56 PM »
I find this hard to make sense of and am confused, not least by your doc's flaky off-label off-guideline approach to HIV treatment during primary infection.

He was of the opinion that begining ART during acute infection would be beneficial to my long term health. I know that the studies on this are not conclusive, and I did some of my own research and wanted to go for it. He had very legitimate reasons for wanting to initiate treatment at that point, so I'd hardly call it flaky.

RNA PCR test's can be false positive, which is why they're not reccomended for diagnosis, but in almost every case of this occuring they show lowever levels of viral load, not almost a million copies - a level which is consistent with acute infection.

And given that I have resistance to a couple drugs, I'm not under any illusion that I'm negative. I don't know how I could not have HIV and still test any resistance. It was just something I'd throw out there, thought someone might have a clue why I would be testing negative this far along.

The drug issue I'm slightly worried about, because this occured to me after leaving the docs so I thougth I'd ask you guys. My VL numbers dropped like a rock, which would lead me to believe that the atripla was effective. Could just the truvada component be responsible for this and could I be on it for 6 weeks without developing resistance to it without a third ARV? Also I'm slightly worried that if any resistance has developed, starting it with isentress tonight could end up making me resistant to Isentress as well.

But the VL number seems to indicate that the Truvada has been working very well. I realize these are very weird numbers. So I'm just looking for some input.

Offline RapidRod

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Re: First numbers
« Reply #7 on: February 14, 2011, 02:37:38 PM »
PCR-RNA tests are supplemental tests used in conjunction with an antibody test. They are not used alone. As for no antibodies it's not possible. Are you seeing an Infectious Disease Doctor?

Offline mdh26

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Re: First numbers
« Reply #8 on: February 14, 2011, 02:54:58 PM »
Yup, I'm seeing an ID specialist.

Offline newt

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Re: First numbers
« Reply #9 on: February 14, 2011, 06:32:13 PM »
So as far as I can see you ain't got a definitive diagnosis and you're on antiretrovrials during possible seroconversion without a resistance test, and oh! you went on a combo you are resistant to, and one which included a crap drug.

this is so wrong.

Hope the new combo works out and your diagnosis is confirmed, rather than not, causing great confusion/difficult choices etc.

On the viral load drop /resistance questions, yes the combo, even with resistance could cause a huge drop in viral load, it just wouldn't maintain it long-term. You are almost certain not to have any resistance to your new combo that is significant (ie will compromise treatment).

- matt
"The object is to be a well patient, not a good patient"

Offline mdh26

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  • Posts: 27
Re: First numbers
« Reply #10 on: February 14, 2011, 06:56:51 PM »
okay thanks. good to know on the resistance issue.

I have almost 3 weeks worth of Atripla available for anyone who needs it.

Offline mdh26

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  • Posts: 27
Re: First numbers
« Reply #11 on: February 16, 2011, 11:49:52 PM »
FYI on this issue, this comes from here: http://www.aids-ed.org/aidsetc?page=cm-108_testing

Quote
O: Objective
During the symptomatic phase of HIV seroconversion, the HIV antibody test is likely to be negative or indeterminate. For patients who have symptoms consistent with seroconversion illness and a recent high-risk history for HIV exposure, an HIV RNA (viral load) test should be performed, in addition to the HIV antibody test, as part of the evaluation. Patients with negative antibody tests but high HIV viral loads (>100,000 copies/mL) can be considered to be infected with HIV, although the antibody test should be repeated later to confirm seroconversion. False-positive HIV viral loads have been reported in approximately 5% of patients who were tested after HIV exposures. A low viral load (<1,000 copies/mL) usually indicates a false-positive result at this stage, because viral loads typically run very high (ie, >100,000 copies/mL and often millions of copies/mL) in acute infection. Patients who have indeterminate HIV antibody test results, low HIV viral loads, and no clear HIV risk factors or symptoms of primary HIV infection should have repeat antibody testing in 4-6 weeks, without other interventions. For patients without significant risk factors, indeterminate results rarely indicate evolving seroconversion.

Treatment

It is reasonable to consider starting combination ART in patients with acute HIV infection, because some limited evidence suggests that treatment initiated during primary HIV infection may preserve HIV-specific immune function that would otherwise be lost as the infection progresses. However, it is not yet clear whether initiating early treatment yields long-term immunologic, virologic, or clinical benefits. The potential advantages of ART for primary infection must be weighed against the possibility of short- and long-term toxicities, the possibility of developing drug resistance, and the adherence challenges associated with starting antiretrovirals quickly in newly diagnosed patients. These issues are complex, and consultation with an HIV expert or referral to a clinical trial is recommended.

and I have 19 doses of atripla which I can send anyone who needs it, just PM me.
« Last Edit: February 16, 2011, 11:52:21 PM by mdh26 »

Offline newt

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  • the one and original newt
Re: First numbers
« Reply #12 on: February 17, 2011, 08:36:47 AM »
Fair point, also covered in detail in the 2011 US guideline for treatment in acute infection, which I post here for the record really:

Panel’s Recommendations:

• It is unknown if treatment of acute HIV infection results in long-term virologic, immunologic, or clinical benefit; treatment should be considered optional at this time .

• Therapy should also be considered optional for patients with HIV seroconversion in the previous 6 months (CIII).

• All pregnant women with acute or recent HIV infection should start a combination antiretroviral (ARV) regimen as soon as possible to prevent mother-to-child transmission (MTCT) of HIV.

• If the clinician and patient elect to treat acute HIV infection, treatment should be implemented with the goal of suppressing plasma HIV RNA to below detectable levels.

• For patients with acute HIV infection in whom therapy is initiated, testing for plasma HIV RNA levels and CD4 count and toxicity monitoring should be performed as described for patients with established, chronic HIV infection (AII).

If the decision is made to initiate therapy in a person with acute HIV infection, genotypic resistance testing at baseline will be helpful in guiding the selection of an ARV regimen that can provide the optimal virologic response; this strategy is therefore recommended (AIII). If therapy is deferred, genotypic resistance testing should still be performed because the result may be useful in optimizing the virologic response when therapy is ultimately initiated.

Because clinically significant resistance to protease inhibitors (PIs) is less common than resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) in antiretroviral therapy (ART)-naïve persons who harbor drug-resistant virus, a ritonavir (RTV)-boosted PI-based regimen should be used if therapy is initiated before drug-resistance test results are available

Ref: Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents - January 10, 2011:  http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf << PDF

Emphasis on resistance testing and choice of regimen if not done is mine.

- matt
"The object is to be a well patient, not a good patient"

 


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